Case discussion: How would you treat this patient? [29 August]

This week we have another real life, apparently simple case from Dr David Smith. A small, apparently innocuous pink lesion.

What is the differential diagnosis?

How would you confirm diagnosis here?

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Case submitted by Dr David Smith

UPDATE:

Diagnosis is confirmed as a superficial BCC – what are your treatment options?

 

Please share your thoughts in the comment section below. Professor David Wilkinson will provide his opinion and advice.


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8 comments on “Case discussion: How would you treat this patient? [29 August]

  1. The blood vessels look very suspicious to me and suggest arborisation
    Thge lesion is mostly made up of extensive pale amorphous ares abutting to solar damaged skin.
    Morphoeic BCC

  2. white pink structureless area with some tiny branched vessels and white line….non specific brown patches. Follow up…..DD- could BCC

  3. Given simple case, to my eye:
    1/ Clinically (gross eye) a small erythema without elevation. Dermoscopically, new vessels (Telangiectasia) with a few arborisation in the pale pinkish background.
    2/ D/Dx: BCC (likely superficial)
    3/ How to manage: biopsy either shaved or 3-4mm punched, and go from there.

    No obvious clues to suspect Melanoma.

  4. The key messages I wanted to get across here are: 1) impossible to make any sort of firm diagnosis here – the appearance is just too non-specific, so the differential ranges from the common (BCC) to the rare (amelanotic melanoma) to the inflammatory etc. So, 2) you need a tissue diagnosis. My approach here would be quick and simple – a 4 or 5 mm punch in the middle of the lesion. So, sBCC is confirmed – what treatment options do you have?

    1. I agree the dermatoscopic image is non-specific, and thus many falls under it. As for SBCC, we can employ creams like aldara and 5FU.